Archive for tag: integrative medicine

Acupuncture or ER?

No one likes to be wrong. No one likes to admit that his or her medicine is not the best. When a patient walks into the room seeking treatment, we each want to be the one to say, "Yes, we can help you." While acupuncture has successfully treated the masses for thousands of years, and has been recommended by the World Health Organization for dozens of conditions and diseases, it's not the only tool in the shed in 2015.


On Thursday at Cook County Hospital, I sat at the computer in a treatment room entering the subjective information from an existing patient presenting with a new chief complaint -- left calf pain. We'd treated her in the acupuncture wing of the outpatient pain clinic before, but her chief complaint was usually lower back pain. Initially, I thought "another case of sciatica," as I worked through her SOAP note and mentally scanned the best acupuncture points for the job.


"Sharp pain in the back of my leg," she said, gingerly touching her left calf. I asked, "When did it start, and have you had this pain before?" "Yesterday, and NO," she snapped back at me. "It's so swollen and the pain is sharp right here," she added. She confirmed that there had been no trauma to the area, and I released my grip and let the pack of needles slide deeper down into my lab coat pocket.

I'm kind of new here, and I readily admit that my weakness as an acupuncture intern is ruling out contraindications and sorting out red flags before I start sticking needles into the patient. Can I still needle you if your blood pressure is 150/90? Some books say yes, some sources say no. Acupuncture lowers blood pressure, so shouldn't we go ahead and do it? Refer out! Confusion. "It's normal," everyone assures me. "You'll gain that confidence through clinical experience over time." Well, as a third year acupuncture student, I don't feel like it's been enough time. I walk into the head clinician's office and start presenting the case. Something just this patient.


The beauty of my internship at Stroger Hospital is that although it's not set up to be an integrative treatment experience for each patient, it can transform into one in under 60 seconds. Our calf pain patient came into the acupuncture wing of the pain clinic, but upon suspicion of an emergency situation (yes, we were all thinking "Deep Vein Thrombosis" or "DVT" at this point in the show), we went two doors down the hall and snagged an MD intern to evaluate her presentation from a western perspective, too.


He quickly assessed her signs and symptoms and agreed that we needed to rule out a DVT before moving ahead with her regularly scheduled acupuncture treatment at that time. Within seconds, our integrated team had changed course, explained the testing process to the patient, called over to the ER, and had a nurse transport the patient.

For thousands of years the expansive Chinese empire developed what we now call "Traditional Chinese Medicine," or "Oriental Medicine," of which acupuncture and herbs form the foundation. A complete and effective medical system, the doctors not only placed needles, administered herbal formulas, gave hands-on manipulations, moxibustion, and cupping treatments, but also did bone-setting and any other emergency medicine that was required. Today, in the United States, our scope of practice is generally not so extensive as to include bone-setting, but we respect the completeness of the TCM system in its entirety.


This does not mean, though, that we ignore the advancements of other medical systems or technologies. It means that instead of blindly accepting the often too-invasive and side-effect ridden treatment plans of the mainstream western medical system, we utilize only the elements that we see as truly necessary or complementary to a holistic treatment plan. In short, I LOVE DIAGNOSTIC IMAGING. Sure, it's wrong sometimes, giving false positives and false negatives alike, but overall it gives us a somewhat clearer look inside the human body than what we can piece together by looking at a patient's tongue and feeling her pulses.

I'm not saying that modern diagnostic imaging is necessary for an acupuncturist to be effective in treating modern patients, but it is another tool in the shed nowadays. The shed has grown larger in the past 50 years, but it's also full of a lot of junk. Often the expert walks in, picks up the best tool for the job -- the one he's trained to use most confidently -- and steps over the rest. The skill is being adept in choosing those tools that are best suited for the situation, even if they aren't from the same pile.

"The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease." Thanks, Thomas A. Edison. I like that quote. Doctors of Oriental Medicine, herbalists, and acupuncturists generally give herbs as part of a complete treatment plan, but giving a pill to pop -- whether pharmaceutical, peppermint, or deer antler-- is not the only way to help.


The doctor of the future will be truly integrative. He will skillfully diagnose the patient's whole body, mind, and spiritual condition, drawing from both hands-on examination findings and high-tech imaging of internal structures. In the future, when the patient presents with the new chief complaint of acute calf pain and swelling, we can use modern imaging to quickly rule out the DVT and then use acupuncture to treat her condition and balance her body. We can give her qi gong exercises and dietary changes to support her long-term health and wellness. Thomas Edison will be proud.


Further Reading: The Patient Will See You Now: The Future of Medicine is in Your Hands by Eric Topol

Is Chinese Medicine Better than Western Medicine?

Is Traditional Chinese Medicine (TCM) better than conventional western medicine? Would a provider of oriental medicine and one of the ayurvedic traditions treat a patient the same way? Do naturopaths diagnose the same medical conditions as chiropractors do? 

The answer to each of these questions is probably a solid "sometimes."

2014-02-04_booksThe point is that one medical system is not necessarily better than another. Each of the above-mentioned categories exist as an entire medical paradigm, complete with its own unique way of diagnosing and treating an array of health-related issues. Did you know that your chiropractor could give you a pelvic exam, ladies? Did you know that your naturopathic doctor could give you a spinal adjustment? And what about those herbs? Why do western naturopaths have a different materia medica than we students of oriental medicine do? Is slippery elm awesome? I'll never know. And neither did the ancient Chinese, because it didn't grow there.

We've all heard that there is competition between the students, all graduating in Lombard at the same moment, as they get dumped out into a market that becomes more and more saturated every day. We all feel it from time to time -- a student of acupuncture who assumes her classes are 10,000 times more difficult than that of the massage student down the hall; the chiropractic intern who thinks he's way more important than any acupuncturist in the clinic; or the naturopath who points out that she can do everything a chiropractor can do and more!

Are they all right? Or are we all just egotistical jerks? Again, the answer is an unreassuring "sometimes."

2014-02-04_elmWhat I'm learning at NUHS is the unmistakable value of the various medical systems. My friends ask me if I scrape my tongue daily or if I've dabbled in oil pulling. No and no, I tell them. That's from the ayurvedic traditions of India, not the ancient Chinese medicine that I'm studying. Does that mean I don't think these practices have merit? Nope. I'm sure they do...I'm just not learning about them in my program. I've actually tried oil pulling, but I'm fairly certain I did it wrong, and I swallowed, which I learned later defeats the point. Whoops. I also love essential oils, and I frankly have no idea which tradition claims them.

What are we learning in the MS in Acupuncture and Oriental Medicine program at NUHS? I've memorized hundreds of acupoints -- well, a good chunk of them anyways -- and dozens of Chinese herbs, I finally realized that ginger and garlic are making it worse when I have a heat invasion, and I'm piecing together why a point on my inner wrist is so helpful for my heart palpitations. I finally learned how to spell "ayurvedic," and I hope I can pronounce "naturopathy" correctly most of the time these days.

2014-02-04_herbsMore importantly, I'm also learning that the "competition" chatter has a much bigger bark than bite. We students of oriental medicine like you students of chiropractic, naturopathy, and massage therapy, and I feel fairly confident assuming that you guys like us, too. In fact, the sheer number of students who dual enroll in more than one program at NUHS proves this point for me.

I value what the other practices and traditions bring to the overall health and well-being of the patient. I don't expect that I'll offer a patient the same knowledge and services that an ND or an MD does; I'll offer them something almost entirely different in fact. And that, my friends, is the point. We have a better shot at helping people if we work together, value each other's contributions and specialties, and keep an open mind to things that might sound crazy at first. Energy crystals...what?!